Insurance Basics for Therapy: What You Need to Know
Pro tip: Sometimes pressing 0 helps you get through the robot and straight to a customer service rep!
If you are considering starting therapy, one of the first questions you may have is “Will my insurance cover this?” Understanding the basics of how therapy and mental health benefits work can save you stress and surprise bills later. Below is a simple breakdown of common terms, how to check your mental health benefits, and what to watch out for when it comes to therapy coverage. (Quick disclaimer: this is general information. Every plan is different, so it’s always best to call your insurance company directly to understand your benefits.)
Common Insurance Terms for Therapy
Deductible: The amount you pay out of pocket each year before insurance starts covering services. For example, if your deductible is $1,500, you must pay that amount before your plan begins sharing costs.
Copay: A set fee you pay for each session, often $20 to $40. This is separate from your deductible.
In-Network: Therapists who have a contract with your insurance company. These sessions are usually more affordable.
Out-of-Network: Therapists who do not have a contract with your insurance. You may still get some reimbursement, but you will usually pay more upfront.
Superbill: An itemized receipt that your therapist can provide if they are out-of-network. You send it to your insurance company for possible reimbursement.
Authorization (Pre-Authorization): Some plans require approval before starting therapy. Without it, sessions may not be covered.
How to Check Your Therapy Benefits
The best way to confirm your coverage is to call the number on the back of your insurance card. When you reach a representative, ask:
What are my outpatient mental health benefits?
What is my deductible, and how much of it has been met?
What is my copay or coinsurance for therapy sessions?
Do I need pre-authorization for counseling or therapy?
Is there a limit on the number of sessions per year?
What is my coverage for out-of-network providers?
It helps to write down the date, the name of the person you spoke with, and their answers in case you need to reference the call later.
Mental Health Coverage and Carveouts
Here’s where it can get a little tricky: sometimes mental health benefits are managed by a separate company, even if your medical insurance is with a big provider. This is called a “carveout.” For example, your health insurance card might say the name of a major insurance company, but your therapy benefits are managed by another company. If that’s the case, your provider will point you to the right place to check coverage.
Final Note
This guide is designed to give you a starting point in understanding insurance coverage for therapy. Every plan is unique, and rules can change. Always confirm your specific benefits directly with your insurance provider before starting therapy.